Diaper Dermatitis

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					               Diaper Dermatitis




Continuity Clinic
                    Objectives
   • Be able to identify common infant diaper
     rashes

   • Understand the factors involved with
     causing irritant diaper dermatitis

   • Know how to treat the common diaper
     rashes
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                    Epidemiology
   • 1990-1997: 4.8 million outpatients visits
      – 75% of these in pediatric offices


   • Peak ages: 9-12 months

   • Often associated with Candida albicans
      – Higher severity associated with C. albicans


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     Factors Involved in Development
   • Combination of:
      –   Diaper occulsion
      –   Fecal enzyme activity activity
      –   Urine
      –   Diaper chaging
   • Leads to:
      – Overhydration of the stratum corneum
      – Chemical and mechanical abrasion
      – Susceptibility to penetration of irritants and microbes


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          Role of Urine and Feces
   • Interaction of urine and feces is
     fundamental in the development of IDD
     (Irritant Diaper Dermatitis)
   • Bacterial ureases in stool degrade urea in
     urine thus releasing ammonia
      – Ammonia does not irritate skin but increases
        local pH which reactivates fecal enzymes
        such as lipase and protease which irritate skin


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               Differential Diagnosis
   • Inflammatory                        • Infectious
      –   Contact Dermatitis                – Candidiasis
      –   Allergic Dermatitis               – Folliculitis
      –   Intertrigo                        – Bullous impetigo
      –   Seborrheic Dermatitis             – Perianal/Intertriginous
      –   Atopic Dermatitis                   streptococcal disease
      –   Psoriasis                         – HSV
      –   Granuloma gluteale infantum       – Scabies
   • Malignancy                             – Congenital Syphilis
      – Langerhans’ cell histiocytosis   • Nutritional/Metabolic
   • Miscellaneous                          – Acrodermatitis enteropathica
      – Miliaria                            – Biotin Deficiency
      – Child Abuse                         – Cystic Fibrosis




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                    Characteristics
   • Irritant Diaper Dermatitis
      – Confluent erythematous papules
      – Scaling
      – Skin Folds Spared
   • Candidiasis Associated
      – Rash > 3 days
      – Irregular, scaly border
      – Satellite lesions
      – Skin Folds involved

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        You Guess the Diagnosis!




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         Irritant Diaper Dermatitis
                                      Spares skin
                                      folds




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                    Candidiasis   Satellite
                                  lesions




In folds of
skin

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                Bullous Impetigo   Note erosions
                                   of skin




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           Streptococcal Intertrigo




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             Management of IDD
   • Nonmedical
      – Frequent diaper changes
      – Gentle cleansing
      – Barrier protection


   • Medical
      – Anti-inflammatory  low potency steroids
      – Anti-fungal  lotrimin, nystatin

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       Commonly Used Barrier Creams
                              ACTIVE INGREDIENTS
   •   Vitamin A&D ointment   Vit. A & D, lanolin
   •   Aquaphor               Petrolatum, lanolin
   •   Aveeno diaper cream    Zinc oxide, dimethicone
   •   Balmex ointment        Zinc oxide
   •   Boudreaux’s paste      Zinc oxide
   •   Desitin                Zinc oxide
   •   Triple Paste           Petrolatum
   •   Zinc Oxide ointment    Zinc oxide

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                      Cleansing
   • Avoid wipes with alcohol product
   • Nonirritating cleansers: cetaphil or mineral oil
   • Do not entirely wipe away barrier preparation –
     wipe away feces and replace what barrier is
     removed
   • Powders?
      – Cornstarch is recommended over talcum powder
      – Talcum powder associated with severe respiratory
        distress caused by inhalation


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              Corticosteroid Use
   • Low potency steroids relatively safe
   • Mid to High Potency corticosteroids
      – Generally contraindicated in occluded areas
        of the skin and can cause skin atrophy, striae,
        tachyphylaxis, and growth delay
      – Abraded skin also increases absorption rates




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